13D1064879 CLIA NUMBER - BOISE GROUP HOMES

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Field Name	Field Value
CLIA Number	13D1064879
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	BOISE GROUP HOMES
Street	5440 W FRANKLIN RD #100
City	BOISE
State	ID
ZIP	83705
Phone	208 376-1861
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	2/15/2025
Certificate Expiration Date	2/14/2027
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	SHAWNA L. RICKETTS

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This page was last updated on: 9/29/2025